The H-ATOMIC criteria for the etiologic classification of patients with Intracerebral Hemorrhage
Martí-Fàbregas, Joan (Institut d'Investigació Biomèdica Sant Pau)
Prats Sánchez, Luis Antonio (Institut d'Investigació Biomèdica Sant Pau)
Martínez Domeño, Alejandro (Institut d'Investigació Biomèdica Sant Pau)
Camps-Renom, Pol (Institut d'Investigació Biomèdica Sant Pau)
Marín Bueno, Rebeca (Institut d'Investigació Biomèdica Sant Pau)
Jiménez Xarrié, Elena (Institut d'Investigació Biomèdica Sant Pau)
Fuentes, Blanca (Hospital Universitario La Paz (Madrid))
Dorado Bouix, Laura (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Purroy Garcia, Francisco (Hospital Arnau de Vilanova (Lleida, Catalunya))
Arias-Rivas, Susana (Hospital Clínico Universitario (Santiago de Compostela, Galícia))
Delgado Mederos, Raquel (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Date:	2016
Abstract:	BACKGROUND AND PURPOSE: There are no generally accepted criteria for the etiologic classification of intracerebral hemorrhage (ICH). For this reason, we have developed a set of etiologic criteria and have applied them to a large number of patients to determine their utility. METHODS: The H-ATOMIC classification includes 7 etiologic categories: Hypertension, cerebral Amyloid angiopathy, Tumour, Oral anticoagulants, vascular Malformation, Infrequent causes and Cryptogenic. For each category, the etiology is scored with three degrees of certainty: Possible(3), Probable(2) and Definite(1). Our aim was to perform a basic study consisting of neuroimaging, blood tests, and CT-angio when a numerical score (SICH) suggested an underlying structural abnormality. Combinations of >1 etiologic category for an individual patient were acceptable. The criteria were evaluated in a multicenter and prospective study of consecutive patients with spontaneous ICH. RESULTS: Our study included 439 patients (age 70. 8 ± 14. 5 years; 61. 3% were men). A definite etiology was achieved in 176 (40. 1% of the patients: Hypertension 28. 2%, cerebral Amyloid angiopathy 0. 2%, Tumour 0. 2%, Oral anticoagulants 2. 2%, vascular Malformation 4. 5%, Infrequent causes 4. 5%). A total of 7 patients (1. 6%) were cryptogenic. In the remaining 58. 3% of the patients, ICH was attributable to a single (n = 56, 12. 7%) or the combination of ≥2 (n = 200, 45. 5%) possible/probable etiologies. The most frequent combinations of etiologies involved possible hypertension with possible CAA (H3A3, n = 38) or with probable CAA (H3A2, n = 29), and probable hypertension with probable OA (H2O2, n = 27). The most frequent category with any degree of certainty was hypertension (H1+2+3 = 80. 6%) followed by cerebral amyloid angiopathy (A1+2+3 = 30. 9%). CONCLUSIONS: According to our etiologic criteria, only about 40% patients received a definite diagnosis, while in the remaining patients ICH was attributable to a single possible/probable etiology or to more than one possible/probable etiology. The use of these criteria would likely help in the management of patients with ICH.
Grants:	Instituto de Salud Carlos III RETICS/RD012/0014
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Published in:	PloS one, Vol. 11, Núm. 6 (Juny 2016) , e0156992, ISSN 1932-6203

DOI: 10.1371/journal.pone.0156992
PMID: 27275863

15 p, 401.4 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles